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Kinesiology > KinesiologyQuiz2Weeks4-5 > Flashcards

KinesiologyQuiz2Weeks4-5 Flashcards

0
Q

On what bone is the external acoustic meatus?

A

temporal bone

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1
Q

Axial Skeleton

A

craniocervical region, vertebral column, sacroiliac joints

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2
Q

What features on the occipital bone serve as attachments for muscles and name the muscles that attach.

A

external occipital protuberance - ligamentum nuchae, trapezius; superior nuchal line - trapezius, splenius capitis; inferior nuchal line - semispinalis capitis (between), obliquus capitis superior (between), RCP major, RCP minor

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3
Q

Mastoid Process

A

easily palpable posterior to the ear, on the temporal bone, attachment for SCM, longissimus, splenius capitis

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4
Q

Atlanto-occipital Joint

A

occipital condyles from the anterior-lateral margins of the foramen magnum form the convex component with the concave superior articular facets of the atlas

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5
Q

Vertebrae Function

A

provide vertical stability throughout the trunk and neck, protect the spinal cord, ventral and dorsal roots, and existing spinal nerve roots

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6
Q

Vertebrae Characteristics

A

anterior - body (weight-bearing); posterior elements (vertebral arch) - transverse and spinous processes, laminae, articular processes; pedicles are bridge between posterior and anterior

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7
Q

Pedicles

A

thick, strong and difficult to break; they transfer muscle force from posterior to disperse across vertebral body and discs

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8
Q

Where in the vertebral column would it be most difficult to slip a disc?

A

thoracic; very stable due to ribs

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9
Q

Ribs Characteristics

A

12 pairs; posterior end - head and tubercle articulate with vertebra (costovertebral and costotransverse joint); anterior end - hyaline cartilage (1-10 attach to sternum but 8, 9, 10 are “false”)

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10
Q

Sternum Characteristics

A

manubrium (first sternocostal, sternoclavicular, jugular notch), body (costal facets), xiphoid process (rectus abdominis, linea alba)

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11
Q

Vertebral Column

A

33 segments; 5 regions; 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal

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12
Q

Normal Curvature

A

lordosis - cervical and lumbar; kyphosis - thoracic and coccygeal; it is dynamic (change with movement and over time) and a reciprocal curve (shared tension), dissipates force

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13
Q

What would be the resultant changes in normal sagittal plane curvature in full extension of the vertebral column?

A

increased cervical and lumbar lordosis, reduced thoracic kyphosis

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14
Q

What would be the resultant changes in normal sagittal plane curvature in full flexion of the vertebral column?

A

decreased cervical and lumbar lordosis, increased thoracic kyphosis

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15
Q

Line of Gravity

A

with ideal posture, the line of gravity passes near the mastoid process of the temporal bone, anterior to the second sacral vertebra, just posterior to the hip, anterior to the knee and ankle

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16
Q

Where is the external torque attributed to gravity greatest?

A

C4 and C5, T6, and L3 (these are the apex of each region’s curvature)

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17
Q

Faulty Posture

A

varying degrees of pelvic tilt, abnormal curvatures can alter the spatial relation between line of gravity and each spinal region, can exert added stress on tissues and change volume of body cavities

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18
Q

Ligamentous Support in the Vertebral Column

A

supraspinous, interspinous, posterior longitudinal, intertransverse, and anterior longitudinal ligaments; apophyseal joint capsule

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19
Q

Which ligament(s) in the vertebral column limit flexion?

A

ligamentum flavum, supraspinous and interspinous, posterior longitudinal, and intertransverse ligaments (lesser extent)

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20
Q

What ligament(s) in the vertebral column limit extension?

A

anterior longitudinal ligament (also limits lordosis)

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21
Q

Which ligament(s) limit contralateral/lateral flexion in the vertebral column?

A

intertransverse ligament

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22
Q

Ligamentum Flavum

A

lamina to lamina, limits flexion, protects disc, will provide support when lamina are removed

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23
Q

Supra- and Interspinous Ligaments

A

spinous processes, limits flexion and provides muscular attachment (trapezius, splenius capitis and cervicis) in C-spine, called ligamentum nuchae in C-spine

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24
Q

Ligamentum Flavum Stress-Strain Relationship

A

fails at 70% beyond its fully slackened length, and would this failure occur during flexion or extension??? just making sure you are still awake

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25
Q

Capsule of Apophyseal Joints

A

facets, taut in all extremes of motion, synovial joints, meniscoids; superior and inferior facet articulations resisting forward flexion

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26
Q

Cervical Vertebrae

A

smallest and most mobile, transverse foramina (vertebral artery), C3-C6 are typical, uncovertebral joints, vertebral canal, short spinous processes, facets orientated in the horizontal plane, uncinate processes limit rotation

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27
Q

Atlas (C1)

A

no body, lamina, spinous process; anterior tubercle (ALL), posterior tubercle (PLL), superior articular facet (occipital condyle), inferior facet (concave)

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28
Q

Axis (C2)

A

large, tall body; dens - superior projection which is axis of rotation for C1; convex superior facet; bifid spinous process

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29
Q

Thoracic Region

A

large transverse processes for costal facet, downward slant of spinous processes, apophyseal joints in frontal plane, costovertebral joints for ribs 2-10, T1 has full facet superior to accept head of 1st rib, T11 & T12 no articulation rib to transverse

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30
Q

Lumbar Region

A

support (large mass); short, thick lamina and pedicles; transverse processes project lateral and spinous horizontal; mamillary processes (multifidi); facets are in sagittal plane (flexion/extension)

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31
Q

Apophyseal Joints

A

superior facets - concave (flat), face medial posterior, sagittal plane (almost); inferior facets - convex (flat), face lateral anteriorlateral

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32
Q

Apophyseal Joint at L5-S1

A

more toward frontal plane, provides anterior-posterior stability

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33
Q

Sacrum

A

triangular bone, weight transmission to pelvis, anterior is concave, foramina for sacral plexus (ughhhhhhhhhhh not another plexus f.m.l.), dorsal is rough fused spinous processes

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34
Q

Coccyx

A

four fused vertebrae, not strong, sacrococcygeal joint, ligamentous support but usually fuses

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35
Q

Role of Transverse and Spinous Processes in Movement and Stability

A

outriggers for attachment of muscles and ligaments

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36
Q

Role of Apophyseal Joints in Movement and Stability

A

geometry, size, and spatial orientation of the articular facets within each apophyseal joint greatly influence the direction of intervertebral motion

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37
Q

Role of Interbody Joints in Movement and Stability

A

shock absorption, load distribution, stability between vertebrae, site of axes of rotation, deformable intervertebral space

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38
Q

Spatial and Physical Relationships

A

=cause and treatment of dysfunction and pathologies

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39
Q

What planes of movement are involved with the osteokinematics of the vertebral column and which region is most associated with each plane?

A

horizontal - cervical; frontal - thoracic; sagittal - lumbar

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40
Q

Spinal Coupling

A

movement in vertebral column is usually associated with automatic motion in another plane; most consistent with axial rotation and lateral flexion

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41
Q

Sagittal Plane Movement

A

medial-lateral axis of rotation, flexion and extension (lumbar)

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42
Q

Frontal Plane Movement

A

anterior-posterior axis of rotation, lateral flexion (thoracic)

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43
Q

Horizontal Plane Movement

A

vertical axis of rotation, axial rotation (cervical)

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44
Q

Arthrokinematics of the Vertebral Column

A

usually articular facet surfaces, relatively low levels of concavity/convexity so surfaces described as flat, additional terms include approximation, separation, sliding

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45
Q

Apophyseal Joint Arthrokinematics

A

24 pairs, plane joints, horizontal facet for axial rotation, vertical facet for sagittal or frontal plane motion (block rotation), combo of horizontal and vertical

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46
Q

Interbody Joint Arthrokinematics

A

intervertebral disc, vertebral endplates (nutrients pass through), adjacent vertebral body, act as combined shock absorber and stabilizer

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47
Q

Lumbar Intervertebral Discs

A

nucleus pulposus, annulus fibrosus

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48
Q

Nucleus Pulposus

A

mid to posterior, gel/water-like, thickened by proteoglycans, type 2 collagen, elastic fibers (mostly)

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49
Q

Annulus Fibrosus

A

layers of collagen fibers, contains NP, high vascularity (on outer fibers - inner has much less ability to heal), collagen fibers stabilize the intervertebral disc, fibers aligned at 65 degrees from vertical in alternating patterns among layers, taut in direction of twist and opposite is slackened

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50
Q

Vertebral Endplates

A

thin caps of fibrocartilage, anatomic bond, semipermeable to allow nutrients to pass

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51
Q

Shock Absorption in the Intervertebral Disc

A

80% interbody joint, 20% posterior structures, protection from compression forces, compressive forces are diverted from nucleus toward the annulus and back to the nucleus and endplates (reduces RATE of loading not necessarily magnitude), stress-sharing

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52
Q

Pressure Measures of Nucleus Pulposus

A

disc pressure under constant change in relation to daily activities, additional load increase pressure substantially, supine lying is best followed by sidelying, sitting back in chair; no forward bending (apply this knowledge to posture mechanics/retraining, lifting mechanics, positional relief)

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53
Q

Intervertebral Disc Health with Aging

A

hydrophilic - likes low pressure for water absorption; unloading spine allows for reabsorption (2 hours supine = 56% reabsorption); less proteoglycans with age so less ability to retain water, more collagen and less elastin, disc can dry out and endplates can fail

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54
Q

Neutral Position Curvatures of the Spine

A

30-35 degrees cervical lordosis, 40 degrees thoracic kyphosis, 45 degrees lumbar lordosis, sacrococcygeal kyphosis

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55
Q

Regional Kinematics of the Spine

A
  1. neutral position, 2. apophyseal joint anatomy, 3. connective tissue limitations of motion
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56
Q

Craniocervical Joint

A
  1. atlantooccipital joint (AO), 2. atlanto-axial joint (AA), 3. apophyseal joints…most mobile region
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57
Q

Atlantooccipital Joint (AO)

A

convex condyle of occipital bone on concave superior facet of atlas; 2 DOF: flex./ext. (mostly), lateral flex.; stability by ALL, anterior and posterior AO membranes

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58
Q

Atlanto-axial (AA) Joint Complex

A

dens (pivot joint), ring created by transverse ligament of atlas and anterior arch of atlas, apophyseal joints, 2 DOF: flex./ext. and mostly rotation, tectorial membrane (continuation of PLL attaches to occipital bone and limits extreme flex./ext.), alar ligament from dens to occipital condyles obliquely limits lateral flexion

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59
Q

Osteokinematics - Craniocervical Flexion and Extension

A

20-25 degrees at AO & AA, rest is apophyseal; axes of rotation (occipital condyles-AO, dens-AA, bodies-C3-C7); flexion results in increased volume of central canal

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60
Q

Arthrokinematics - Craniocervical Flexion and Extension

A

AO - roll and slide; AA - atlas pivots; apophyseal - slide of facet from above segment (ext. 70 degrees is closed pack, flex. 35 degrees, C5-6 most - where injuries likely)

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61
Q

Protraction of the Cranium

A

lower-to-mid cervical spine flexes as the upper craniocervical region extends

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62
Q

Retraction of the Cranium

A

lower-to-mid cervical spine extends as the upper craniocervical region flexes

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63
Q

Osteokinematics - Axial Rotation

A

90 degrees each direction, 1/2 at AA and other 1/2 is apophyseal joints, limitation at AO

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64
Q

Arthrokinematics - Axial Rotation

A

AA - atlas rotates about the dens (axis of rotation); tension of alar ligaments; apophyseal - orientation of facets allows (horizontal)

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65
Q

Cervicocranial Lateral Flexion

A

osteokinematics - 40 degrees each direction, 5 degrees at AO; arthrokinematics - coupled rotation to same side (lateral flexion tends to include rotation unless muscle activation occurs simultaneously)

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66
Q

How would full flexion affect the intervertebral foramen at typical cervical spine vertebrae (C3-C6)?

A

increases volume of intervertebral foramen (decompress spinal nerve root)

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67
Q

Thoracic Region Structure and Function

A

rigid rib cage - ribs, T-vertebrae, sternum; stable base for C-spine/head, protection of thoracic organs, respiration, much less movement; articular structures - 24 apophyseal joints 0-30 degrees from vertical, costovertebral joints, costotransverse joints

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68
Q

Costovertebral Joints

A

head of a rib with a pair of costal facets and adjacent margin of an intervening intervertebral disc, stabilized by radiate and capsular ligaments

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69
Q

Costotransverse Joints

A

articular tubercle of a rib to the costal facet on the transverse process of a corresponding thoracic vertebra, stabilized by a capsular (costotransverse) ligament and the superior costotransverse ligament

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70
Q

Kinematics - Thoracic

A

osteokinematics - flexion 30-40 degrees, extension 20-25 degrees, rotation 30 degrees, lateral flexion 25 degrees; arthrokinematics - inferior facet of superior vertebra slides on superior facet of inferior vertebra

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71
Q

Arthrokinematics - Lateral Flexion

A

frontal plane facet orientation, limitation of ribs, downslide facet ipsilateral and upslide facet contralateral

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72
Q

Arthrokinematics - Rotation

A

short distance of slide, limited by facet orientation in frontal plane, mid to lower T-spine block horizontal plane movement; 80 degrees of craniocervical rotation plus 40 degrees of thoracolumbar axial rotation so 120 degrees total rotation

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73
Q

Deformities in Thoracic Spine

A

excessive kyphosis - 42 degrees is normal; excessive could be trauma, postural habits, work habits; kyphosis in relation to osteoporosis

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74
Q

Postural Considerations

A

normal - small cervical extension torque and small thoracic flexion torque; moderate thoracic hyperkyphosis - moderate cervical flexion torque and moderate thoracic flexion torque; severe thoracic hyperkyphosis - small cervical exttension torque and large thoracic flexion torque

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75
Q

Scoliosis

A

abnormal curvature - mainly frontal and horizontal; functional vs. structural; identified with direction of convexity of lateral deformity

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76
Q

Lumbar Region

A

articular structures: L1-L4 sagittal, vertical facets; L5-S1 frontal plane

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77
Q

Sacrohorizontal Angle

A

base of sacrum to horizontal 40 degrees, anterior shear force with increased angle (increased lordosis, orientation of L5-S1 facets resist shear forces), pars interarticularis - between sacrum and inferior facet of L5, this is fractured in severe anterior spondylolisthesis at the L5-S1

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78
Q

Kinematics of Lumbar Region

A

50 degrees flexion, 15 degrees extension, 20 degrees lateral flexion, 5 degrees rotation,

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79
Q

Lumbar Flexion

A

arthrokinematics same as T-spine, forces transmission: apophyseal joints - overstretched will lose ability to protect discs, posterior fibers of annulus fibrosis

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80
Q

Lumbar Flexion - IV Foramen & Nucleus Pulposus

A

full flexion - 19% increase in IV foramen, 11% increase in vertebral canal, anterior compression of disc, nucleus pulposus migrates posterior; extension - 11% decrease in IV foramen, 15% decrease in vertebral canal, migration of nucleus pulposus anterior

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81
Q

Herniated Nucleus Pulposus

A

protrusion, prolapse, extrusion (annular fibers disrupted), sequestration (free nuclear material)

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82
Q

Lumbopelvic Rhythm

A

normal kinematic strategy used to flex the trunk from standing position incorporating a near simultaneous 40 degrees of flexion of the lumbar spine and 70 degrees of hip flexion (limited in one will cause excessive in the other)

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83
Q

Pelvic Tilt and the Lumbar Spine

A

short-arc tilt of the pelvis, links movement of hip joint to lumbar spine, anterior or posterior

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84
Q

Anterior Pelvic Tilt

A

tight trunk extensors, tight hip flexors, lumbar extension (lordosis), shifts nucleus pulposus anteriorly and reduces diameter of IV foramen

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85
Q

Posterior Pelvic Tilt

A

tight hip extensors and lower abdominals, lumbar flexion (decreased lordosis), shift the nucleus pulposus posterior and increase the diameter of IV foramen

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86
Q

Sitting Posture - Describe Slouched Posture at Each Vertebral Region

A

ideal sitting posture optimizes support and lack of stress to bone, ligament and muscle; slouched posture = posterior pelvic tilt (decreased lumbar lordosis), increased T-spine kyphosis, cervical protraction

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87
Q

Lumbar Spine - Axial Rotation

A

limited to 5 degrees, near sagittal plane orientation of facets blocks, arthrokinematics - in left rotation the right inferior facet of superior vertebra approximates with right superior facet of inferior vertebra AND left inferior facet of superior vertebra distracts from the left superior facet of inferior vertebra

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88
Q

Lumbar Spine - Lateral Flexion

A

15-20 degrees, similar arthrokinematics to T-spine but orientation of facets is sagittal, nucleus pulposus migrates towards convexity, coupled motion (axial rotation opposite direction due to lordosis)

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89
Q

Sacroiliac Joints

A

transition between axial and appendicular, mixed conclusions on efficacy of diagnostic clinical testing and effectiveness of clinical interventions, palpation is key here

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90
Q

SI - Anatomical Considerations

A

pelvic ring - transfer of body weight; dependent on fit and stability of sacrum between two halves of pelvis; SI joint - anchoring of sacrum to pelvis

91
Q

SI - Structure and Support

A

articulation of matching, rigid surfaces; age - joint fibroses (fuse often); ligamentous support

92
Q

Ligaments That Stabilize SI Joint

A

primary - anterior sacroiliac, iliolumbar, interosseous, short and long posterior sacroiliac; secondary - sacrotuberous, sacrospinous

93
Q

Thoracolumbar Fascia

A

mechanical stability, compartmentalize posterior mm of low back, anterior/middle/posterior layers

94
Q

SI Joint Kinematics

A

sagittal plane; nutation - anterior sacral on ilium rotation, posterior iliium on sacral rotation; counternutation - posterior sacral on ilium rotation, anterior ilium on sacral rotation

95
Q

What ligament does nutation pull taut?

A

sacrotuberous ligament

96
Q

SI Joint Kinematics - Function

A

stress relief within pelvic ring - nutation increases with walking and childbirth; stable means for load transfer - increases compression forces for stability (closed chain), stabilizes SI joint (gravity, ligament, muscle activation)

97
Q

What factors contribute to stabilization in the SI joint?

A

downward force of gravity, upward joint reaction force, nutation torque produced for stability

98
Q

Stabilizing Effect of Muscular Activation on SI

A

muscular driven nutation mechanically locks the SI joint, strengthening these muscles to stabilize, stability training, aka don’t break your hip when you are old and frail

99
Q

Four Articulations of the Elbow and Forearm Complex

A

humeroulnar and hummeroradial; proximal and distal radioulnar

100
Q

Humeroulnar Joint

A

tight fit between trochlea and trochlear notch

101
Q

Humeroradial Joint

A

not so tight, aka radiocapitular

102
Q

Elbow Flexion/Extension

A

medial-lateral axis of rotation, passing through lateral epicondyle, modified hinge joint

103
Q

Normal Valgus Angle of the Elbow

A

asymmetry in the trochlea causes the ulna to deviate laterally relative to the humerus, aka normal carrying angle is cubitus valgus (15-18 degrees), excessive valgus (30 degrees), varus (-5 degrees)

104
Q

What is associated with excessive valgus?

A

stretched medial ligaments and flexors, compression in radial capitulum

105
Q

Which ligaments would be stretched in the elbow during valgus?

A

medial collateral (posterior and anterior) ligament (and ulnar nerve)

106
Q

Which ligaments would be stretched in the elbow during varus?

A

radial collateral and lateral (ulnar) collateral ligaments

107
Q

Which ligaments are stretched during external rotation and associated with “Tommy John” surgery?

A

anterior and posterior medial collateral ligaments

108
Q

When is the intracapsular air pressure within the elbow capsule lowest?

A

80 degrees of flexion

109
Q

Kinematics in the Elbow

A

elbow flexion contracture or loss of forward reach, normal elbow flexion is 145 degrees and normal elbow extension is -5 degrees, impact on shoulder and scapula for reaching

110
Q

Functional Arc

A

most activities fall within 30-130 degrees of elbow flexion

111
Q

Arthrokinematics - Humeroulnar Joint

A

concave trochlear notch and trochlea of the humerus; several tissues including ligament, muscle tension, ulnar nerve, and dermis change stiffness as elbow is passively extended and flexed

112
Q

Which capsule is stretched during flexion in the elbow?

A

posterior (lateral collateral ligaments)

113
Q

Arthrokinematics - Humeroradial Joint

A

cuplike/concave radial head & convex shaped, rounded capitulum at humerus

114
Q

Interosseous Membrane of the Forearm

A

fibers of the interosseous membrane of the forearm are directed away from the radius in an oblique medial and distal direction, tension from radius through interosseous membrane when pushing

115
Q

Why does a distracting force on the radius result in injury more often as opposed to compression force?

A

distal pull on radius slackens the interosseous membrane, stresses the oblique cord and the annular ligament, muscle contraction necessary to hold/compress radial head to joint

116
Q

Proximal Radioulnar Dislocation

A

“pulled elbow syndrome,” radial head slips through distal side of annular ligament (children have laxity!)

117
Q

Catching oneself from a fall (severe valgus) may result in what structures being affected (and how)?

A

severe valgus, rupture of medial collateral ligament and compression forces within humeroradial joint

118
Q

Which joints allow the forearm to rotate into pronation and supination?

A

proximal and distal radioulnar joints (pronation and supination does not occur in the elbow or wrist)…notes also say radiocapitular joint (spin) so take it or leave it people

119
Q

Proximal Radioulnar Joint

A

humeroulnar and humeroradial joint share one articular capsule, radial head is held against the ulna by a fibro-osseus ring (75% annular ligament and 25% radial notch of the ulna), quadrate ligament

120
Q

Distal Radioulnar Joint

A

convex head of the ulnar shallow concavity formed by the ulnar notch of the radius & proximal surface of articular disc (disc has some attachments to palmar and dorsal radioulnar joint capsule ligaments)

121
Q

Ulnocarpal Complex

A

articular disc is part of a larger set of connective tissue known as ulnocarpal complex (TFCC)

122
Q

Triangular Fibrocartilage Complex (TFCC)

A

occupies the space between the distal ulna and ulnar side of proximal carpal bones, primary stabilizer of distal radioulnar joint, important during dynamics of pronation and supination

123
Q

How many degrees of pronation and supination are normal and what is the functional arc?

A

75 degrees of pronation and 85 degrees supination; 100 degree functional (50 degrees each way), functional movements are linked to IR and ER

124
Q

How are the capsular ligaments stretched during pronation and supination?

A

pronation - stretch dorsal capsular ligament; supination - stretch palmar capsular ligament

125
Q

What structures limit supination?

A

pronator mm, palmar capsular ligament at distal radioulnar joint, interosseous membrane & quadrate ligament, oblique ligament, TFCC

126
Q

What structures limit pronation?

A

supinator, biceps mm, dorsal capsular ligament at distal radioulnar joint, TFCC

127
Q

Weight Bearing/Closed-Kinetic Chain Pronation/Supination

A

radius becomes fixed and ulna is performing movement (changes arthrokinematics), ER at shoulder produces pronation at the radioulnar joints

128
Q

Musculocutaneous Nerve

A

from the lateral cord of the brachial plexus, pierces coracobrachialis then lies between biceps and brachialis, becomes lateral cutaneous nerve of forearm at elbow

129
Q

Radial Nerve

A

posterior cord, supplies triceps and passes behind humerus in spiral groove, lies between brachioradialis and brachialis at elbow, gives off superficial and deep terminal branches

130
Q

Ulnar Nerve

A

medial cord, no branches to arm, lies behind medial epicondyle, gives off dorsal branch, forms deep and superficial branches (flexor carpi ulnaris and medial flexor digitorum profundus)

131
Q

Median Nerve

A

medial and lateral cords, no branches to arm, passes into forearm between heads of pronator teres, gives off palmar cutaneous branch, passes into hand below flexor retinaculum

132
Q

Elbow Flexors

A

biceps brachii, brachialis, brachioradialis, pronator teres (which one does NOT participate in pronation/supination?)

133
Q

Elbow and Shoulder Flexion

A

flexion at shoulder shortens biceps and results in faster contraction velocity, extension at shoulder slows contraction of biceps (slower velocity produces stronger contraction due to isometric) and force couple with posterior delt

134
Q

Elbow Extension

A

anconceus first to initiate, medial head (workhorse) of triceps, only with moderate-to-high levels does the nervous system recruit lateral and then long head…anc–>med–>lat–>long

135
Q

What movement is typically associated with elbow extension (explosive pushing)?

A

shoulder flexion

136
Q

When is the internal moment arm of the elbow extensors greatest?

A

full elbow extension

137
Q

When is the peak elbow extensor torque (degrees)?

A

90 degrees of flexion (length-tension over rules leverage in this situation)

138
Q

What is the most powerful supinator of the forearm at 90 degrees?

A

biceps brachii (tendon is near a 90 degree angle of insertion), mostly supination torque and not flexion torque at this angle, significantly reduced when elbow is not flexed to 90 degrees

139
Q

What prevents the forearm from flexing when you are tightening a screw?

A

triceps (counterbalances forces of biceps to flex)

140
Q

What is the most active and consistently used pronator?

A

pronator quadratus

141
Q

What is the primary pronator and what muscle acts against it to neutralize the tendency to flex the elbow?

A

pronator teres (EMG activity), triceps

142
Q

Two Major Articulations of the Wrist Joint

A

radiocarpal and midcarpal joints (felx./ext/ and ulnar/radial deviation)

143
Q

What feature separates the tendon of extensor carpi radialis brevis from the tendon of the extensor pollicis longus?

A

dorsal (Lister’s) tubercle

144
Q

Ulnar Tilt

A

of the radius, 25 degrees, allows wrist and hand rotate farther into ulnar deviation than into radial deviation

145
Q

Palmar Tilt

A

of the radius, 10 degrees, accounts for the greater amounts of flexion than extension at the wrist

146
Q

Proximal Row of Carpal Bones

A

scaphoid (most common fracture), lunate (common dislocation), triquetrum, and pisiform

147
Q

Distal Row of Carpal Bones

A

trapezium (forms saddle joint with first metacarpal), trapezoid, capitate (axis of rotation), hamate

148
Q

Carpal Tunnel

A

transverse carpal ligament forms arch, passageway for the median nerve and 8 tendons

149
Q

Wrist Arthrology - Radiocarpal

A

radiocarpal joint - 80% of weight-bearing force passes through scaphoid and lunate to radius, distal surface of radius and articular disc (concave) and proximal surface of scaphoid, lunate, triquetrum (convex)

150
Q

Wrist Arthrology - Midcarpal

A

medial compartment - distal surfaces of scaphoid, lunate, and triquetrum (concave) and head of capitate and apex of hamate (convex); lateral compartment - proximal surfaces of trapezium and trapezoid (concave) and distal pole of scaphoid (convex)

151
Q

Triangular Fibrocartilage Complex (TFCC)

A

primary stabilizer of the distal radio-ulnar joint, reinforces the ulnar side of the wrist, forms part of the concavity of the radiocarpal joint, helps transfer compression forces that cross hand to forearm (20%)

152
Q

Wrist Osteokinematics

A

2 DOF (flex./ext. and ulnar/radial deviation), rotates in sagittal plane about 130-140 degrees of flex./ext. (flexion exceeds extension by 10-15 degrees) and wrist rotates in frontal plane 45-55 degrees of ulnar/radial deviation

153
Q

Wrist Arthrokinematics

A

firm articulation between capitate and base of third metacarpal causes it to direct osteokinematics of entire hand, motion occurs simultaneous at radiocarpal and midcarpal joints

154
Q

Axis of Rotation for Wrist Movement

A

head of capitate

155
Q

Wrist Flexion and Extension

A

radiocarpal joint - articulation between radius and lunate; medial compartment of midcarpal joint - lunate and capitate; carpometacarpal joint - rigid articulation between capitate and base of third metacarpal

156
Q

Wrist Flexion and Extension Roll and Slide

A

synchronous convex-on-concave rotation at the radiocarpal and midcarpal joints (central column theory does not account for all the carpal bones that participate in the motion

157
Q

Ulnar Deviation

A

radiocarpal and midcarpal joints contribute fairly equally to overall wrist motion

158
Q

Radial Deviation

A

most radial deviation occurs at midcarpal joint

159
Q

Rotational Collapse of Wrist

A

proximal row of carpal bones subject to rotational collapse in a zigzag manner when compressed from both ends, dislocation prevented by resistance from ligaments, tendons, and intercarpal articulations

160
Q

Rotational collapse (“zigzag”) of the wrist could occur due?

A

palmar or dorsal radiocarpal ligament damage (VISI or DISI), or translocation of the carpus

161
Q

What is one reason for the instability of the lunate?

A

no muscular attachment

162
Q

What structure provides the mechanical link between the lunate and distal row of carpal bones?

A

scaphoid (compression forces may fracture scaphoid and tear the scapholunate ligament)

163
Q

What is the most common lunate dislocation?

A

distal articular surface faces dorsally, clinically referred to as dorsal intercalated segment instability (DISI)

164
Q

Which direction would the carpus be more likely to translocate?

A

ulnar tilt of the radius creates a natural tendency for the carpus to slide in an ulnar direction (resisted by ligamentous support)

165
Q

Do muscles of the wrist cross the wrist directly anterior-posterior or medial-lateral to its axis of rotation?

A

no, all muscles have moment arms of varying lengths to produce torques in both the sagittal and frontal planes

166
Q

How does the extensor retinaculum aid wrist extension?

A

prevents extensor tendons from bowstringing up and away from the radiocarpal joint during active extension

167
Q

Wrist Extensors and Making a Fist

A

wrist extensors - position and stabilize the wrist for activities involving fingers; flexion in fingers is counterbalanced by wrist extension

168
Q

For grip strength, what optimizes length-tension relationship of the extrinsic finger flexors to maximize grip strength?

A

wrist in 35 degrees of extension and 5 degrees of ulnar deviation

169
Q

Why would preventing the wrist from flexing maintain extrinsic finger flexors more conducive to higher force production?

A

prevents active insufficiency

170
Q

Lateral Epicondylitis

A

tennis elbow, occurs from stress to proximal attachment of wrist extensors; activities requiring forceful grasp can overwork wrist extensors especially extensor carpi radialis brevis

171
Q

Which wrist flexor does not cross the wrist in the carpal tunnel…let’s say I don’t have a palmaris longus?

A

flexor carpi radialis passes in a separate tunnel formed by a groove in the trapezium and fascia from adjacent transverse carpal ligament

172
Q

Which wrist flexor produces the greatest torque?

A

flexor carpi ulnaris

173
Q

Wrist Flexors vs. Extensors

A

wrist flexors have a total CSA twice that of muscles that extend the wrist

174
Q

Radial Deviation Torque

A

extensor carpi radialis longus–>abductor pollicis longus–>extensor carpi radialis brevis

175
Q

Name the Two Ulnar Deviators of the Wrist

A

extensor carpi ulnaris and flexor carpi ulnaris

176
Q

Name the Radial Deviators of the Wrist

A

extensor carpi radialis l. and b., extensor pollicis l. and b., flexor carpi radialis, abductor pollicis longus, flexor pollicis longus

177
Q

Prehension

A

can be described as grip or pinch, key is thumb and fingers work together, power and precision

178
Q

Osteology of Hand

A

CMC, MCP, IP joints, thumb has one IP, fingers have PIP and DIP

179
Q

How many phalanges?

A

14, similar in morphology, concave base and convex head

180
Q

Arches of Hand

A

proximal transverse arch (distal row of carpal bones - capitate - static), distal transverse arch (MCP - mobile), longitudinal arch (2nd and 3rd MCP)

181
Q

Metacarpal Position of Thumb

A

rotated almost 90 degrees medially at rest in anatomical position

182
Q

Thumb Opposition

A

combines flexion and abduction

183
Q

Thumb Movement

A

flexion/extension in frontal plane and abduction/adduction in sagittal plane

184
Q

CMC Joints

A

distal row of carpal and base of metacarpals, stable central pillar - 2nd and 3rd, peripheral are capable of folding around the hand’s central pillar, allows concavity of palm to fit around objects (intermetacarpal joints)

185
Q

1st Carpometacarpal (CMC)

A

base of 1st metacarpal and trapezium, saddle shape and loose capsule allows opposition

186
Q

CMC Joint of the Thumb

A

2 DOF abd./add. and flex./ext.; opposition and reposition of the thumb are derived from the two primary planes of motion at the CMC joint

187
Q

Abduction and Adduction in Thumb Arthrokinematics

A

convex metacarpal moving on the concave longitudinal diameter of the trapezium

188
Q

Flexion and Extension in Thumb Arthrokinematics

A

concave surface metacarpal moving on convex transverse diameter on the trapezium

189
Q

Opposition of the Thumb CMC Joint

A

phase 1 - abduction, phase 2 - flexion and medial rotation; guided by opponens pollicis at least 45-60 degrees of medial rotation

190
Q

Metacarpophalangeal Joints

A

ovoid articulations, convex metacarpal head, concave proximal phalange base

191
Q

MCP

A

radial and ulnar collateral ligaments, palmar plates, fibrous digital sheaths, three deep transverse metacarpal ligaments

192
Q

MCP Joint Osteokinematics

A

flexion-extension and abduction-adduction, passive rotation at MCP is greatest at 4th and 5th, overall range of flexion and extension increases from 2nd to 5th, MCP can be passively hyperextended 30-45 degrees

193
Q

MCP Arthrokinematics

A

60-70 degrees of flexion collateral ligaments taut, 0 degrees of extension collateral ligaments slacken and palmar plate makes total contact with head of metacarpal, near extension collateral ligaments slacken allowing maximal accessory motions, full hyperextension limited by stretch on palmar plate

194
Q

MCP Arthrokinematics

A

MCP flexion and extension is concave on convex; close-packed position at 70 degrees of flexion (taut collateral ligaments), flexed position = stability

195
Q

MCP Flexion and Extension

A

occurs in sagittal plane about a medial-lateral axis of rotation through head of metacarpal

196
Q

MCP Abduction and Adduction

A

occurs in frontal plane and anterior-posterior axis of rotation through head of metacarpal

197
Q

MCP Arthrokinematics in Thumb

A

MCP joint of thumb and sesamoid bone, one degree of freedom with flexion/extension in frontal plane, hyperextension of thumb limited to a few degrees

198
Q

Tongue-in-groove Articulation at IP Joints

A

guides articulation in flex./ext., restricts axial rotation

199
Q

PIP Joint Composition

A

capsule, radial and ulnar collateral ligaments bend and reinforce palmar plate

200
Q

Palmar Check-Rein Ligaments

A

resist hyperextension of the PIP joint along with palmar plates, not found in DIP

201
Q

PIP & DIP Kinematics

A

PIP flex 100-120 degrees; DIP flex 70-90 degrees; IP flexion greater in ulnar digits; minimal hyperextension at PIP; DIP hyperextension up to 30 degrees

202
Q

Close-packed Position of IP

A

near full extension; due to stretch placed on palmar plate (immobilize in this position after injury due to stretch on palmar plate, collateral ligaments, extrinsic finger flexor muscles to reduce likelihood of finger flexion contracture)

203
Q

Flexors of the Digits

A

flexor digitorum superficialis - flex the PIP and all joints it crosses; flexor digitorum profundus - sole flexor of DIP and also flexes all joints it crosses; flexor pollicis longus - sole flexor at IP of the thumb, also at MCP & CMC joints of thumb and wrist joint

204
Q

Which tendons pass through the carpal tunnel and what synovial sheath surrounds each?

A

ulnar synovial sheath - flexor digitorum superficialis and profundus; radial synovial sheath - flexor pollicis longus (median nerve passes under the transverse carpal ligament but the ulnar nerve is over it)

205
Q

Which wrist flexors do not pass through the carpal tunnel?

A

flexor carpi radialis and ulnaris

206
Q

Flexor Pulleys

A

bands of tissue embedded within each digital sheath function to hold the underlying tendons at a relatively fixed distance from the joints; nutrition and lubrication provided by digital synovial membrane

207
Q

In a finger with rheumatoid arthritis, the bowstringing force in the MCP joint can cause rupture of what structure? (proximal phalanx dislocates in palmar direction)

A

collateral ligaments; the passive tension in these stretched ligaments in healthy finger resists palmar pull

208
Q

Which muscles would act as a proximal stabilizer if you were attempting to flex only the IPs in the 3rd digit?

A

extensor digitorum and extensor carpi radialis brevis

209
Q

Passive Finger Flexion via Tenodesis Action of the Digital Flexors

A

extending the wrist produces passive flexion at fingers and thumb through stretch on extrinsic digital flexors (profundus)

210
Q

Tenodesis

A

stretching of a multi-joint muscle across one joint that generates a passive movement of another

211
Q

Extensors of Fingers

A

lack the defined digital sheath and pulley system of the finger flexors, extensor tendons integrated into fibrous expansion of connective tissue located along length of dorsum of each finger so intrinsics assist with IP extension

212
Q

What would result if extensor digitorum contracted alone?

A

hyperextends of the MCPs but creates claw, must contract intrinsics to extend IPs and undo claw

213
Q

Extrinsic Extensors of the Thumb

A

extensor pollicis longus and brevis and abductor pollicis longus (anatomic snuffbox), tendons of abductor pollicis longus and extensor pollicis brevis pass together through a fibrous tunnel within the extensor retinaculum

214
Q

Intrinsic Muscles of the Hand

A
  1. thenar eminence; 2. hypothenar eminence; 3. two heads of the adductor pollicis; 4. lumbricals and interossei
215
Q

Thenar Eminence

A

median nerve, abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, affected by carpal tunnel syndrome

216
Q

Hypothenar Eminence

A

ulnar nerve, flexor digiti minimi, abductor digiti minimi, opponens digiti minimi, palmaris brevis, cups the ulnar border of the hand and deepens distal transverse arch

217
Q

Adductor Pollicis

A

oblique and transverse heads lying deep in the web space of the thumb, produces force twice that of the average of all muscles of the thenar eminence

218
Q

Lumbricals

A

four slender muscles arising from tendons of flexor digitorum profundus, distal attachment blends into oblique fibers of dorsal hood (pull through the central and lateral bands of the extensor mechanism)

219
Q

Intrinsic-plus Position

A

MCP joint flexion and IP joint extension

220
Q

Extrinsic-plus Position

A

MCP joint hyperextension with IP joint flexion

221
Q

Interaction of Extrinsic and Intrinsic Muscles of the Fingers

A

intrinsic muscle contraction - intrinsic-plus position; extrinsic muscle contraction - extrinsic-plus position; most meaningful motions involve interaction of BOTH

222
Q

What muscles are responsible for completely opening the hand (full extension of IP)?

A

extensor digitorum & intrinsic muscles

223
Q

Closing Hand

A

synergistic activation of wrist extensor muscles, mainly extensor carpi radialis brevis, neutralize strong wrist flexion

224
Q

Ulnar Drift Deformity

A

at MCP joint consists of excessive ulnar deviation and ulnar translation of the proximal phalanx, often common in advanced stages of RA and occurs in conjunction with palmar dislocation of MCP joint

225
Q

Swan-neck Deformity

A

overstretched palmar plate causes hyperextension in PIP, passive tension caused by stretch on flexor digitorum profundus tendon causes partial flexion at DIP

226
Q

Boutonniere Deformity

A

ruptured central band, lateral bands slip in palmar direction relative to PIP joint so it remains partially flexed, DIP remains hyperextended because of increased passive tension in the taut lateral bands

Kinesiology (6 decks)

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